N.M. Code R. § 6.50.7.12 - APPROVAL OR DISAPPROVAL OF REQUEST FOR WAIVER OF PARTICIPATION

The authority board shall approve or disapprove a waiver of participation based on the documentation submitted by the school district or charter school. The board shall grant a waiver to a school district or charter school that shows evidence to the satisfaction of the board that:

A. In the event the waiver is with regard to group health insurance:

(1) that the school district or charter school has secured a valid written enforceable commitment from an insurer to provide group health insurance;

(2) that the coverage committed to the school district or charter school and the plan benefits for their employees is at least as beneficial as the plan being procured by the authority;

(3) that there are no more exclusions from coverage and the exclusions are not broader than those set out in the authority's request for proposals;

(4) that the deductibles, stop loss, out of pocket costs, etc., if any, result in no more costs to the employees than would occur pursuant to the authority's request for proposals;

(5) that any cost containment features not result in any higher costs or burdens on the employees than would result under the authority's request for proposals;

(6) that the prospective insurer of the school district or charter school have the same or greater rating as that required in the authority's request for proposals;

(7) that the notice of intent to request a waiver has been timely filed;

(8) that the request for waiver of participation has been timely filed;

(9) that all the data required to be included in the request for waiver of participation has been timely supplied;

(10) that the proposed insurer for the school district or charter school has satisfactorily demonstrated to the school district or charter school and to the authority that the insurer in its proposal to the school district or charter school has adequately accounted in its rates for such items as school district or charter school experience, incurred but not reported losses, medical inflation trends and other relevant factors for the purpose of allowing the school district or charter school and the authority to determine the future viability of the plan, if rates are under-quoted at inception and whether the proposed insurer for the school district or charter school meets the minimum financial standards of the authority; and

(11) that the total group health insurance offering available in that school district or charter school compares favorably in all respects with the authority's request for proposals;

B. In the event the waiver is with regard to risk-related insurance:

(1) that the school district or charter school has secured a valid written enforceable commitment from an insurer to provide risk-related insurance;

(2) that there are no more exclusions from coverage and the exclusions are not broader than those in the authority's request for proposal;

(3) that the deductibles, self insured retention, etc., if any, are no higher or result in any more costs to the school district or charter school than would occur pursuant to the authority's request for proposal;

(4) that any cost containment features not result in any higher costs or burdens on the school district or charter school than would result under the authority's request for proposals;

(5) that the prospective insurers of the school district or charter school provide coverages as broad as is required in the authority's request for proposals;

(6) that the prospective insurers of the school district or charter school have the same or greater rating as required in the authority's request for proposals;

(7) that the notice of intent to request a waver has been timely filed;

(8) that the request for waiver of participation has been timely filed;

(9) that all the data required to be included in the request for waiver of participation has been included; and

(10) that the proposed insurer for the school district or charter school has satisfactorily demonstrated to the school district or charter school and to the authority that the insurer in its proposal to the school district or charter school has adequately accounted in its rates for such items as school district or charter school experience, incurred but not reported losses, the nature of existing coverage(claims made or occurrence) and other relevant factors for the purpose of allowing the school district or charter school and the authority to determine the future costs of coverages, to determine if rates are under-quoted at inception and whether the proposed insurer for the school district or charter school meets the minimum financial standards of the authority.

Notes

N.M. Code R. § 6.50.7.12

10-31-86, 11-4-88, 3-22-93; Recompiled 10/31/01 Adopted, New Mexico Register, Volume XXV, Issue 16, August 29, 2014, eff. 9/1/2014